Department of Gynecologic Oncology and Reproductive Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America.
Gynecol Oncol. 2018 Dec;151(3):428-432. doi: 10.1016/j.ygyno.2018.10.017. Epub 2018 Oct 23.
To determine the concordance between the laparoscopic scoring assessment and extent of disease identified at primary tumor reductive surgery (TRS) in patients with advanced ovarian cancer.
From April 2013 to June 2017, we prospectively triaged patients with stage IIA to IVB ovarian cancer to laparoscopic scoring assessment. A validated predictive index value (PIV) score (range: 0-14) was assigned. Patients with PIV scores <8 were offered primary surgery and those with score ≥8 received NACT. Patients who underwent primary TRS had a second PIV score based on laparotomy findings. Concordance percentages were calculated between the two scores. Positive predictive value (PPV) was calculated to reflect the performance of the laparoscopic PIV score to predict R0 (complete gross resection) at TRS.
226 patients underwent laparoscopic scoring assessment, of which 139 (61.5%) had a PIV score <8 and 81 (35.8%) had a PIV score ≥8. 6 patients (2.7%) were unscoreable. There was 96% overall concordance between PIV scores at laparoscopy and primary TRS. Concordance scores by location were: bowel infiltration 74.7%, mesenteric disease 84.6%, liver surface involvement 86.5%, omental disease 89.7%, diaphragm disease 92.9%, stomach infiltration 94.7%, peritoneal carcinomatosis 94.8%. A laparoscopic PIV score of <8 had a PPV of 85.4% at predicting R0 at primary TRS.
Laparoscopic assessment of tumor burden is a feasible tool to predict R0 cytoreduction in patients with advanced ovarian cancer. Concordance between PIV scores at laparoscopy and primary TRS varied by anatomic location, with the lowest concordance seen in predicting bowel infiltration.
确定腹腔镜评分评估与晚期卵巢癌患者原发性肿瘤减瘤术（TRS）中所识别疾病程度的一致性。
从 2013 年 4 月至 2017 年 6 月，我们前瞻性地将 IIA 期至 IVB 期卵巢癌患者分为腹腔镜评分评估组。分配了一个经过验证的预测指数值（PIV）评分（范围：0-14）。PIV 评分<8 的患者接受原发性手术，评分≥8 的患者接受新辅助化疗（NACT）。接受原发性 TRS 的患者根据剖腹手术结果获得第二个 PIV 评分。计算了两个评分之间的一致性百分比。阳性预测值（PPV）用于反映腹腔镜 PIV 评分预测 TRS 时 R0（完全肉眼切除）的性能。
226 例患者接受了腹腔镜评分评估，其中 139 例（61.5%）的 PIV 评分<8，81 例（35.8%）的 PIV 评分≥8，6 例（2.7%）无法评分。腹腔镜和原发性 TRS 时 PIV 评分的总体一致性为 96%。按部位划分的一致性评分如下：肠浸润 74.7%，肠系膜疾病 84.6%，肝表面受累 86.5%，网膜疾病 89.7%，膈肌疾病 92.9%，胃浸润 94.7%，腹膜癌病 94.8%。腹腔镜 PIV 评分<8 时，预测原发性 TRS 时 R0 的 PPV 为 85.4%。
腹腔镜评估肿瘤负荷是预测晚期卵巢癌患者 R0 减瘤术的一种可行工具。腹腔镜和原发性 TRS 时 PIV 评分的一致性因解剖部位而异，预测肠浸润的一致性最低。
